Chung Shiu-Dong, Huang Kuo-How, Lai Ming-Kuen, Huang Chao-Yuan, Chen Chung-Hsin, Pu Yeong-Shiau, Yu Hong-Jeng, Chueh Shih-Chieh
Department of Surgery, Division of Urology, Far Eastern Memorial Hospital, Ban-Ciao, Taiwan.
Am J Kidney Dis. 2007 Nov;50(5):743-53. doi: 10.1053/j.ajkd.2007.08.007.
The aim of this study is to examine chronic kidney disease (CKD) as a risk factor for bladder recurrence and cancer-specific and total mortality in a cohort of patients with upper urinary tract (UUT) urothelial carcinoma (UC) treated by means of nephroureterectomy.
Cohort study.
SETTINGS & PARTICIPANTS: 150 patients with primary UC of the ureter or renal pelvis treated by means of nephroureterectomy at a single center.
Presence and severity of CKD according to preoperative markers of kidney damage, estimated glomerular filtration rate calculated using the Modification of Diet in Renal Disease Study equation, and other covariates.
OUTCOMES & MEASUREMENTS: Subsequent bladder recurrences, cancer-specific survival, and overall survival.
Of 150 patients, 37 (25%) had no CKD, 71 patients (47%) had CKD stages 1 to 4, and 42 patients (28%) had CKD stage 5. 41 (27%) and 31 patients (21%) reported exposure to herbal medicine or tobacco use, respectively. During a mean follow-up of 4 years, 53 patients (35%) developed bladder recurrence and 27 (18%) died, of whom 14 (9.3%) died of cancer. Overall 5-year bladder recurrence-free and cancer-specific survival rates were 62% and 89%, respectively (n = 150). Risks of bladder recurrence were 2.43 (95% confidence interval, 1.00 to 5.93) and 3.95 (95% confidence interval, 1.59 to 9.80), greater in patients with CKD stages 1 to 4 and CKD stage 5 compared with patients without CKD, respectively. Ureteral involvement of the primary tumor (hazard ratio, 1.97; 95% confidence interval, 1.12 to 3.48) also was associated significantly with an increased rate of bladder recurrence. The risk of death from all causes or UC was not significantly greater in patients with CKD stages 1 to 4 or CKD stage 5 compared with those without CKD. Higher tumor stage (pT2 to 4) was associated significantly with overall death (hazard ratio, 5.15; 95% confidence interval, 1.84 to 14.48).
A retrospective study in an area of high incidence of both UUT-UC and CKD.
Advancing CKD stage of patients and positive ureteral involvement of the primary tumor (especially in the lower ureter) are associated with greater risk of subsequent bladder recurrence in patients with UUT-UC treated by means of radical surgery.
本研究旨在探讨慢性肾脏病（CKD）作为上尿路（UUT）尿路上皮癌（UC）患者队列中行肾输尿管切除术治疗后膀胱复发、癌症特异性死亡和全因死亡的危险因素。
队列研究。
在单一中心接受肾输尿管切除术治疗的150例原发性输尿管或肾盂UC患者。
根据术前肾脏损伤标志物、使用肾脏病膳食改良研究方程计算的估计肾小球滤过率以及其他协变量确定的CKD的存在和严重程度。
后续膀胱复发、癌症特异性生存和总生存。
150例患者中，37例（25%）无CKD，71例（47%）为CKD 1至4期，42例（28%）为CKD 5期。分别有41例（27%）和31例（21%）患者报告曾使用草药或吸烟。在平均4年的随访期间，53例（35%）患者出现膀胱复发，27例（18%）死亡，其中14例（9.3%）死于癌症。总体5年无膀胱复发生存率和癌症特异性生存率分别为62%和89%（n = 150）。与无CKD的患者相比，CKD 1至4期和CKD 5期患者的膀胱复发风险分别为2.43（95%置信区间，1.00至5.93）和3.95（95%置信区间，1.59至9.80）。原发性肿瘤累及输尿管（风险比，1.97；95%置信区间，1.12至3.48）也与膀胱复发率增加显著相关。与无CKD的患者相比，CKD 1至4期或CKD 5期患者的全因死亡或UC死亡风险并无显著增加。较高的肿瘤分期（pT2至4）与总体死亡显著相关（风险比，5.15；95%置信区间，1.84至14.48）。
在UUT-UC和CKD均高发地区进行的一项回顾性研究。
对于接受根治性手术治疗的UUT-UC患者，CKD病情进展以及原发性肿瘤输尿管阳性累及（尤其是输尿管下段）与后续膀胱复发风险增加相关。
